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General NPI Number Information
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NPI Number | 1235527649
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Entity Type | Individual
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Provider Name | TONJIA MARIE MILLER SW
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Gender | Female
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Dates
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Enumeration Date | 01/07/2015
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Last Update Date | 01/08/2015
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Provider Practice Location Address
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Address Line | 410 CYPRESS AVE
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City | CLARKSDALE
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State | MS
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Zip | 38614-2610
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Country | US
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Telephone | 662-902-1503
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Fax | 662-624-4462
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Provider Business Mailing Address
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Address Line | 410 CYPRESS AVE
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City | CLARKSDALE
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State | MS
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Zip | 38614-2610
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Country | US
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Telephone | 662-902-1503
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Fax | 662-624-4462
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 10
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License Number State | MS
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